Self-reported dental status and treatment need among elderly people.

A convenience sample of 180 elderly residents of Council flats in Wanganui were interviewed about their dental health and experiences of dental care. Thirty percent of the sample were dentate, and this was higher among younger subjects. Life-long or mostly life-long dental attendance was reported by 43 percent, and this was higher among individuals of higher socioeconomic status and those who had been educated to secondary school level or more. Life-long attenders were more likely to be dentate. Approximately one-third of subjects reported a current problem or dental treatment need.

Root caries: some clinical aspects.

This paper has discussed some aspects of root surface caries which are of special relevance to the clinician. Epidemiological studies have suggested that root caries is not inevitable after gingival recession, but a small number of patients show a propensity for development of new lesions. Several risk factors have been identified. Thorough prophylaxis is essential for accurate diagnosis of root caries lesions, and radiographs can identify lesions which would otherwise be difficult to detect. The activity of any particular lesion can only be evaluated by observation at successive examinations. Fluoridated water may have a role in the prevention of root caries, but the evidence is not conclusive. Other forms of topical fluoride have been demonstrated to be effective. Cleansable and accessible lesions can be arrested with good oral hygiene and topical fluoride therapy. Teeth which require restoration may be restored with GIC, but limitations of the material make this unsuitable for all but readily accessible lesions, or where margins are supragingival. Clinicians should not rely on the fluoride released from GIC in situations where another material may provide a better restoration; in many situations, amalgam may be the material of choice. The longevity of bonded amalgam restorations has not been established, and conventional methods of amalgam retention remain a requirement of every restoration.

Dentists' opinions of the effect of changes in Accident Compensation Corporation regulations on dental practice and patient access to dental services.

A 50 percent random sample of practising dentists in New Zealand was invited to complete a questionnaire aimed at determining their opinions on the effects of changes to Accident Compensation Corporation regulations on dental practice and patient access to treatment. Seventy-six percent of those surveyed returned the survey form. The results suggested that the introduction of a fee schedule for dental treatment in 1989 restricted practitioners' treatment decisions, and prevented some patients from receiving what was considered to be ideal care, largely on the basis of cost. Although the scheduled fee did not always cover the cost of treatment, many practitioners absorbed this shortfall. However, since the 15 percent cut in fees payed by ACC, which was introduced in 1992, practitioners are now finding it necessary to charge the patient for the amount not covered by ACC. Dentists state that this is further restricting the kind of treatment they can provide, and that patients can afford. Some patients are now unable to have any treatment for dental injuries resulting from accidents as they cannot afford it. Some practitioners feel that the introduction of a fee schedule and the requirement of a patient contribution to treatment costs have had some positive effects, but the majority feel that significant barriers to treatment have been created by the ACC changes.

The oral health and attitudes to dental treatment of a dentate elderly population in Mosgiel, Dunedin.

As part of the Mosgiel Community Study, a longitudinal investigation of the health of the elderly, a dental survey was used to determine the oral health status and treatment needs, both objective and subjective, of a group of dentate older adults. Sixteen percent of the 817 subjects were dentate. Of these, 95 were available for the dental survey, and they were questioned and examined at their homes. The mean age was 77 years, and 55 percent of subjects were male; disproportionately more older males than females had retained some of their natural teeth. Seventy-two percent regularly sought dental treatment, and 39 percent felt they were in need of treatment. Few real barriers to treatment were identified, although a major obstacle preventing many from seeking treatment was their lack of perceived need. However, even the realisation that they required treatment was not sufficient cause for many to seek treatment. All subjects required some form of dental treatment. Eighty-five of the 95 subjects required at least one restoration, and 16 percent advanced restorative treatment. The frequencies of coronal and root surface caries were similar. Oral mucosal pathology was also common. Sixty-five percent of denture wearers required prosthetic treatment. Most subjects needed simple periodontal treatment, but 11 percent required advanced therapy. The main oral health problems of this group related to the simple management of plaque-related disease, and the wearing of dentures. However, 24 percent of people required complex restorative and periodontal treatment, or both.

Current issues in gerodontology.

Gerodontology involves much more than the treatment of dental disease in people aged over 65 years. Using the definition of Ettinger, a relatively distinct group of individuals are defined. However, a slightly broader definition is perhaps more appropriate, to include those who are in any way handicapped in the receipt of dental treatment due to their age. This group of patients may become victims of ageist behaviour by dentists. This may influence their treatment options, and become a barrier to older patients receiving the full range of treatment they may require. However, the elderly generally consider oral health to be of low priority, and many, including those with identifiable problems, do not have a perceived need for care. The main barrier to their seeking treatment is their own attitude to their problems, and only a few experience barriers that otherwise prevent their utilisation of dental treatment. The dental needs of the elderly can be anticipated to rise as more retain their teeth, many of which will be heavily restored. The cost of this treatment must be met by someone; if the patient cannot afford it, the State may be asked to provide the funds. On present form, the response to this suggestion is likely to be unfavourable, but a cheap alternative to specialist care is not desirable, as it will only be able to partially perform the task. There is a need for research in a variety of aspects of gerodontology.(ABSTRACT TRUNCATED AT 250 WORDS)